Interdisciplinary Treatment Team Research Articles

Practice effects of personalized interventions with interdisciplinary teamwork in type 2 diabetes remission: a retrospective study.

A retrospective analysis of the clinical outcomes of personalized interventions for type 2 diabetes mellitus (T2DM) in an interdisciplinary team. Under the guidance of an interdisciplinary team, 40 patients with T2DM underwent a systematic examination at the beginning of the intervention, 3 months after the intervention, and 3 months of follow-up at the end of the intervention (i.e., at 6 months). Key indicators such as fasting plasma glucose (FPG), 2-hour postprandial glucose (2hPG), fasting insulin level (FINS), glycated hemoglobin (HbA1c), blood lipids, and body mass index (BMI) were measured. After the 3-month intervention, participants' BMI, FPG, 2hPG, FINS, and HbA1c improved significantly, with statistically significant differences (P<0.05).These metrics remained essentially stable at the 3-month follow-up. Of all the participants, 92.5% (37 cases in total) successfully discontinued their medication after 3 months of intervention, of which 80% (32 cases) remained stable during the 3-month follow-up after discontinuation, fulfilling the criteria for remission of T2DM; 2 cases successfully reduced the dose of their medication, and only 1 case was maintained on the original treatment. Through an interdisciplinary team intervention strategy, we significantly optimized the glucose metabolism, lipid metabolism, and BMI status of patients with T2DM, making diabetes remission an achievable goal, which provides valuable experience for further optimization of diabetes prevention and control protocols.

Chronic Pain in Autistic Youth: Clinical Prevalence and Reflections on Tailoring Evidence-Based Interventions from an Interdisciplinary Treatment Team.

Though there is growing awareness of the overrepresentation of autistic patients in chronic pain clinics, potential adaptations for the assessment and treatment of chronic pain in this population have not yet been established. To address this gap, a retrospective review of electronic medical records and discussions by an interdisciplinary pain treatment team were summarized to inform potential biopsychosocial factors affecting the presentation, assessment, and treatment of chronic pain in autistic youth. Our sample included a record review of 95 patients receiving treatment in an interdisciplinary outpatient pediatric pain clinic. Results indicated that 9% (n = 9) of the patients presented to the clinic with a prior diagnosis of autism, but an additional 21% (n = 20) were identified as likely meeting criteria for autism based on the clinical assessment of the developmental history, behaviors observed during the clinical encounter(s), and expert clinical judgment, suggesting that the prevalence rate of autism may be closer to 30% in our outpatient pediatric pain clinic. Over half (52%) of the autistic youth presented to the clinic with widespread pain, 60% identified as female, and 6% identified as gender expansive or transgender. Qualitative insights revealed that most of the autistic patients had co-occurring sensory-processing challenges and difficulty in describing their pain, emotions, and somatic experiences and exhibited cognitive inflexibility and social challenges. We summarize our team's clinical reflections on how autism-relevant biopsychosocial vulnerability factors may contribute to the experience of pain in autistic youth and propose treatment targets and adaptations for the assessment and treatment of pain in this population. Finally, we recommend the need for interventions focused on sensorimotor integration, especially for autistic youth, and describe how pain clinics may be particularly helpful for identifying and supporting autistic females, for whom the potential role of autism in pain experiences had not been considered until receiving treatment in our clinic.

Usability of a telerehabilitation program for patients with musculoskeletal or oncological diseases: A mixed-methods evaluation / Benutzerfreundlichkeit eines Telerehabilitations-Programmes für Patient*innen mit muskuloskelettalen oder onkologischen Erkrankungen: Eine Mixed-Methods Evaluation

Abstract Purpose Telerehabilitation may stabilize the results of a previous phase 2 rehabilitation program through remote rehabilitation sessions. We evaluated a new telerehabilitation service (PV RehaTRAIN®) during its initial implementation, focusing on its usability both from the perspective of patients with musculoskeletal or oncological diseases and the interdisciplinary treatment team. Methods The evaluation followed a convergent mixed-methods design. After separate qualitative and quantitative analyses of the multi-perspective findings from interviews, focus groups and questionnaires, we interpreted the results collectively and equally. Results Overall, the results indicate high acceptance of and satisfaction with the new telerehabilitation service, especially from the patients’ perspective and regarding educational and individual counselling sessions. However, the treatment team identified a need for further didactic training to enable them to realize their full professional potential in a telerehabilitation setting. Conclusion The new telerehabilitation service PV RehaTRAIN® may bridge gaps in health care for patients who do not have access to conventional phase 3 rehabilitation infrastructure or prefer remote services that are readily integrated into their everyday lives. Members of the interdisciplinary treatment team offering telerehabilitation for the first time need adequate technical and especially setting-specific didactic training. Increased participation of treatment teams when refining telerehabilitation systems may minimize problems in early implementation phases and contribute to the quality of care.

Critical Care in Older People in Low and Middle-Countries (LMICs): Comprehensive Geriatric Assessment (CGA) Protocol in Andes Mountains

Background: The number of older adults in ICU care is increasing. Nowadays, at least fifty percent of ICU patients are aged 65 years and older. The most frequent pathologies to be admitted to the ICU in older people include acute diseases, long-term conditions, and acute or chronic disease exacerbations. Furthermore, new clinical phenotypes, and geriatric syndromes (falls, frailty, immobility) result from the interaction of age-associated conditions and comorbidity. Severity of index disease, multimorbidity, premorbid functional status, frailty, nutritional status, and cognitive level are more important determinants of long-term outcome than chronological age. Comprehensive geriatric assessment (CGA) is a recognized and useful instrument in the management of elderly patients. Methods: We present a protocol for a clinical trial on the application ofCGA in ICU in the Andes Mountains in Colombia, a Low and Middle-Income Country (LMIC). This protocol could provide valuable information for the integration of geriatrics into critical care and provide practical information on how to implement CGA in this context. Results: The selection criteria of the tools to be used during the assessment of the patients were based on the available literature review and on reviews about interdisciplinary team interventions in acute care services based on the CGA. Conclusion: The care of critically ill elderly patients in the ICU is challenging due to factors such as frailty, psychosocial vulnerability, cognitive impairment, dependence on activities of daily living, and the presence of geriatric syndromes which are important conditions for adverse health outcomes in the future. CGA technology could be considered an excellent tool for managing older people in ICU.

What to report in sellar tumor MRI? A nationwide survey among German pituitary surgeons, radiation oncologists, and endocrinologists

PurposeWhile MRI has become the imaging modality of choice in the diagnosis of sellar tumors, no systematic attempt has yet been made to align radiological reporting of findings with the information needed by the various medical disciplines dealing with these patients. Therefore, we aimed to determine the prevailing preferences in this regard through a nationwide expert survey.MethodsFirst, an interdisciplinary literature-based catalog of potential reporting elements for sellar tumor MRI examinations was created. Subsequently, a web-based survey regarding the clinical relevance of these items was conducted among board certified members of the German Society of Neurosurgery, German Society of Radiation Oncology, and the Pituitary Working Group of the German Society of Endocrinology.ResultsA total of 95 experts (40 neurosurgeons, 28 radiation oncologists, and 27 endocrinologists) completed the survey. The description of the exact tumor location, size, and involvement of the anatomic structures adjacent to the sella turcica (optic chiasm, cavernous sinus, and skull base), occlusive hydrocephalus, relationship to the pituitary gland and infundibulum, and certain structural characteristics of the mass (cyst formation, hemorrhage, and necrosis) was rated most important (> 75% agreement). In contrast, the characterization of anatomic features of the nasal cavity and sphenoid sinus as well as the findings of advanced MRI techniques (e.g., perfusion and diffusion imaging) was considered relevant by less than 50% of respondents.ConclusionTo optimally address the information needs of the interdisciplinary treatment team, MRI reports of sellar masses should primarily focus on the accurate description of tumor location, size, internal structure, and involvement of adjacent anatomic compartments.

Navigating Countertransference in Inpatient Settings: Optimizing Interventions for Patients with Borderline Personality Disorder and Repeated Acute Hospitalizations.

Over the years, the psychiatric inpatient treatment paradigm has shifted to more brief stays focused on acute stabilization and psychopharmacologic-focused interventions, rather than individual psychotherapeutic engagement. Unfortunately, this has allowed patients with complex interpersonal dynamics, particularly borderline personality disorder, to slip through the cracks of effective treatment. This can contribute to repeated inpatient admissions, where both patients and clinicians feel trapped in a maladaptive, unhelpful cycle. In this article, we examine the evolution of inpatient treatment with de-emphasized psychotherapy practices, review the particular dynamics that patients with borderline personality disorder may evoke within an interdisciplinary treatment team, and provide a framework of clinically based vignettes for scenarios that may arise within inpatient treatment of this patient population. With attention to countertransference patterns and common pitfalls of communication, we offer alternative approaches and conversations with the hopes of improving outcomes and alliances in a new landscape of psychiatric practice.

A survey on oral health-related standard of care for head and neck cancer patients in the EU.

To map oral health-related standard of care in the context of head and neck cancer (HNC) treatment across the European Union (EU). Six hundred and ninety centers across the European Union were contacted. The questionnaire contained questions focusing on the team/department structure, HNC treatment planning routines, and assessment and handling of dental treatment needs prior to cancer treatment. Eighty-seven centers across the EU responded. Department structure and number of HNC patients treated per year varied widely and dental professionals are included as part of the team in about 25% of the centers. Standard of care, in terms of dental assessment and preventive dentistry routines, such as recording an orthopantomogram, offering dental treatment, and providing a radiation protection splint and splint for fluoride application, differed significantly among the European regions. Independent of the region, these aspects are positively affected if dental professionals are part of the interdisciplinary treatment team and if dental treatment is offered within the center. Dental professionals are still only to a very limited extent included in interdisciplinary treatment planning teams of HNC patients. However, their inclusion and/or offering dental treatment within the same hospital/center appears to improve oral health-related standard of care. Inclusion of dental professionals in treatment planning teams of HNC patients appears to improve oral health-related standard of care within HNC treatment.

Impact of personality dysfunction on interdisciplinary treatment team working alliance in an inpatient psychiatric population.

Cluster B personality disorders (PDs) share specific traits that can result in interpersonal conflict. As therapeutic working alliance has a strong relationship with improved outcomes, there is interest in understanding the relationship between PDs, working alliance, and clinical outcomes. This is especially compelling in inpatient populations, where symptoms are severe, and patients are working with a treatment team. The aims of this study were to (a) assess whether higher team working alliance is associated with lower depressive symptoms, (b) assess whether patients with Cluster B PD traits have worse working alliance with their team than patients without those Cluster B PD traits, and (c) assess whether higher team working alliance is associated with lower depressive symptoms when Cluster B PD traits are present. Team working alliance was measured at baseline and at discharge for 3,406 inpatients at a psychiatric hospital. Improved team working alliance was associated with lower depression scores at discharge. Patients with borderline personality disorder traits had worse team working alliance, whereas patients with narcissistic personality disorder and antisocial personality disorder traits had similar working alliance scores as other patients. Borderline personality disorder and antisocial personality disorder traits moderated the association between team working alliance and depressive symptoms differently. Findings suggest that team working alliance works similarly to therapist working alliance. Of clinical importance is the finding that team working alliance and its relationship with depression symptoms differ based on Cluster B PD traits, and the importance of strong working alliance regardless of interpersonal challenges due to personality pathology. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Good handling practice of parenterally administered medicines in neonatal intensive care units - position paper of an interdisciplinary working group.

This position paper, developed by an interdisciplinary expert group of neonatologists, paediatric infectious disease physicians, clinical pharmacists and specialists for the prevention and control of nosocomial infections, describes the "Good handling practice of medicines parenterally administered to patients on NICUs". It takes equal account of patient safety and the specialties of neonatal intensive care regarding feasibility and proportionality. The overall concept is perceived as a "learning system", in which open communication within the health-care team relating to medication errors and critical incidents enables continuous development and improvement to ensure patient safety. In our opinion, pharmacists, who are responsible for the supply of ready-to-administer parenteral medicinal products for neonatal intensive care patients, as well as the hygiene staff responsible on site are integral parts of the interdisciplinary treatment team. Risks of the current clinical practice of parenteral treatment of NICU patients are discussed in detail and recommendations for safety-relevant procedures are given.

Positive Organizational Psychology Factors as Serial Multiple Mediators of the Relationship between Organization Support and Job Satisfaction Among Peer Support Specialists.

Research has demonstrated the effectiveness of peer support specialists in helping people with severe mental illness increase community tenure, decrease hospitalization, boost treatment satisfaction, improve social functioning, and increase quality of life. The purpose of the present study was to evaluate positive organizational psychology constructs as serial multiple mediators of the relationships between perceived organizational support and job satisfaction among peer support specialists. One hundred and twenty-one peer support specialists from the Texas statewide peer certification training programs and the National Association of Peer Supporters participated in the present study. These peer support specialists completed an online survey composed of self-report measures related to perceived organizational support, positive organizational psychology factors, and job satisfaction. A serial multiple mediation (SMMA) analysis was conducted to evaluate autonomous motivation to work, work engagement, and organizational commitment as mediators of the relationship between perceived organizational support and job satisfaction. The SMMA model accounted for 49% of the variation in job satisfaction scores (R2 =. 49, f2 = 0.96 [> 0.35], a large effect size). Autonomous motivation to work, work engagement, and organizational commitment were significantly associated with job satisfaction after controlling for the effect of perceived organizational support. Perceived organizational support increased autonomous motivation to work, work engagement, organizational commitment, and job satisfaction. Peer support specialists are integral members of the interdisciplinary mental health treatment team. Leaders of community-based mental health and rehabilitation agencies who are committed to hire and retain peer support specialists must provide strong organizational support and develop interventions to increase peer support specialists' autonomous motivation to work, work engagement, and organizational commitment as a job retention and career development strategy.

The role of the Neuropsychologist across the stages of recovery from acquired brain injury: a summary from the pediatric rehabilitation Neuropsychology collaborative

ABSTRACT Neuropsychologists working in a pediatric neurorehabilitation setting provide care for children and adolescents with acquired brain injuries (ABI) and play a vital role on the interdisciplinary treatment team. This role draws on influences from the field of clinical neuropsychology and its pediatric subspecialty, as well as rehabilitation psychology. This combination of specialties is uniquely suited for working with ABI across the continuum of recovery. ABI recovery often involves a changing picture that spans across stages of recovery (e.g., disorders of consciousness, confusional state, acute cognitive impairment), where each stage presents with distinctive characteristics that warrant a specific evidence-based approach. Assessment and intervention are used reciprocally to inform diagnostics, treatment, and academic planning, and to support patient and family adjustment. Neuropsychologists work with the interdisciplinary teams to collect and integrate data related to brain injury recovery and use this data for treatment planning and clinical decision making. These approaches must often be adapted and adjusted in real time as patients recover, demanding a dynamic expertise that is currently not supported through formal training curriculum or practice guidelines. This paper outlines the roles and responsibilities of pediatric rehabilitation neuropsychologists across the stages of ABI recovery with the goal of increasing awareness in order to continue to develop and formalize this role.

The Potential for Using Extended Reality Technology in Interdisciplinary Case Discussions and Case Planning in Stereotactic Radiosurgery: Proof-of-Concept Usability Study

Background Extended reality (XR) is a term that captures a variety of techniques, such as augmented reality (AR) and mixed reality (MR), which allow users to interact with virtual models in real time. This technology has an emerging role in several applications within neurosurgery. XR can be useful in enhancing how radiosurgical cases are planned. Multidisciplinary team (MDT) review is an essential part of the radiosurgery case planning process; during case discussions, patient images are reviewed, usually in 2D or 3D modifications. The current commercially available platforms for this review need improvement. Objective We describe a novel visualization application, titled “NeuroVis” by our development team, which uses an XR Microsoft HoloLens headset to provide an interactive 3D visualization of a patient’s neuroanatomy in stereotactic surgery (SRS) case planning discussions. Methods We present examples of 6 common radiosurgery indications to demonstrate the utility of NeuroVis to solve common visualization hurdles in MDTs. Results The utility of NeuroVis is demonstrated through 6 common brain tumor SRS cases as a proof-of-concept illustration of the utility of NeuroVis to enhance radiosurgery case discussion by improving visualization of the standard neuroimaging used in radiosurgery treatment planning by MDTs. Conclusions The NeuroVis application provides several interactive features that produce an enhanced ability to place participating members of an interdisciplinary treatment team on the same visualization plane. This technology, by facilitating team discussions and case review, has the potential to improve the efficiency, efficacy, and safety of radiosurgery treatment planning and, as a result, to optimize patient care.

Functional Cognition: An Opportunity to Highlight the Role of Occupational Therapy in Post-Concussion Care

As concern surrounding concussion and the associated long-term effects grow, a continued need for comprehensive, holistic concussion care emerges. Occupational therapists are well-equipped to address the wide variety of symptoms and deficits that clients may experience post-concussion. Functional cognition is one area in which occupational therapists can demonstrate their unique value on the interdisciplinary treatment team. In this Opinions in the Profession paper, we describe how occupational therapists are poised to further establish their role in post-concussion care by becoming the primary discipline for assessing and treating functional cognition. The aim of this paper is to outline the role of occupational therapy in post-concussion care in regard to becoming the primary discipline for assessing and treating functional cognition and distinguishing occupational therapists as experts in functional cognition. Implications for practice, education, and research are discussed.

Patient-Reported Experiences With Median Arcuate Ligament Syndrome: Resilience and Resources Required.

Median arcuate ligament syndrome (MALS) is a vascular condition that is treated surgically. MALS is a diagnosis of exclusion and therefore often requires that pediatric patients undergo an exhaustive number of tests and potential experiences with misdiagnosis before receiving an accurate diagnosis and treatment. The purpose of the current mixed-methods study was to assess the pediatric patient- and parent-reported experience of (a) coping with and managing symptoms associated with MALS and (b) the diagnostic, treatment, and recovery process for pediatric MALS. Nine postsurgical pediatric patients (M age = 20.11 ± 3.59; all <18 at time of surgery) and 6 parents participated in semistructured focus groups and completed self-report questionnaires about their experiences and current functioning. Four themes emerged: (a) the impact of MALS (physical and psychosocial), (b) uncertainties and feeling misunderstood, (c) extensive medical tests, and (d) mental health impacts, with an additional three themes related to specific querying (i.e., appreciation, recommendations, and interdisciplinary treatment team). With the exception of variable long-term physical impacts, patients and their parents reported fairly consistent experiences, and the content of these themes was consistent with self-reported quantitative data. The current study highlights the resilience and resources seemingly required for effective diagnosis and intervention for pediatric MALS. The need for increased knowledge about MALS, the inclusion of an interdisciplinary treatment team, and long-term follow-up for pediatric patients with MALS are implicated.

Machine learning directed interventions associate with decreased hospitalization rates in hemodialysis patients

BackgroundAn integrated kidney disease company uses machine learning (ML) models that predict the 12-month risk of an outpatient hemodialysis (HD) patient having multiple hospitalizations to assist with directing personalized interdisciplinary interventions in a Dialysis Hospitalization Reduction Program (DHRP). We investigated the impact of risk directed interventions in the DHRP on clinic-wide hospitalization rates. MethodsWe compared the hospital admission and day rates per-patient-year (ppy) from all hemodialysis patients in 54 DHRP and 54 control clinics identified by propensity score matching at baseline in 2015 and at the end of the pilot in 2018. We also used paired T test to compare the between group difference of annual hospitalization rate and hospitalization days rates at baseline and end of the pilot. ResultsThe between group difference in annual hospital admission and day rates was similar at baseline (2015) with a mean difference between DHRP versus control clinics of −0.008 ± 0.09 ppy and −0.05 ± 0.96 ppy respectively. The between group difference in hospital admission and day rates became more distinct at the end of follow up (2018) favoring DHRP clinics with the mean difference being −0.155 ± 0.38 ppy and −0.97 ± 2.78 ppy respectively. A paired t-test showed the change in the between group difference in hospital admission and day rates from baseline to the end of the follow up was statistically significant (t-value = 2.73, p-value < 0.01) and (t-value = 2.29, p-value = 0.02) respectively. ConclusionsThese findings suggest ML model-based risk-directed interdisciplinary team interventions associate with lower hospitalization rates and hospital day rate in HD patients, compared to controls.

RARE-04. IMPACT OF LIVE, VIRTUAL EDUCATIONAL SYMPOSIA ON PEDIATRIC NEURO-ONCOLOGIST, NEURO-ONCOLOGIST, AND NEUROSURGEON CONFIDENCE, KNOWLEDGE, AND INTENTION TO EMPLOY TARGETED MEDICAL THERAPIES FOR THEIR PATIENTS WITH NEUROFIBROMATOSIS TYPE 1

Historical treatment options and management strategies for neurofibromatosis type 1 (NF1) have been limited, with a relative paucity of clinical studies and the traditional paradigm focused on an ineffectual, and possibly even harmful, trimodal combination of radiation, surgery, and surveillance. Fortunately, an emerging preponderance of trial data supporting the use of targeted medical therapies, including MEK inhibitors and multi-kinase TKIs, is expanding the stale treatment paradigm and broadening horizons for patients. Given the profound novelty of this paradigmatic shift in NF1 management, it is imperative that timely, adaptive, and evidence-based educational initiatives be developed and delivered to the interdisciplinary neuro-oncology treatment team in an effort to bridge both learning and practice gaps. With an appreciation of the intrinsically multi-system nature of NF1, which necessitates a longitudinal treatment approach encompassing the totality of the multidisciplinary team, CEC Oncology designed and tailored targeted NF1 educational activities to improve confidence, advance knowledge, and promote enhanced utilization of targeted medical therapies among pediatric neuro-oncologists, neuro-oncologists, and neurosurgeons who manage patients with NF1. We conducted two independent satellite symposia, one at the 2020 Society for Neuro-Oncology (SNO) Annual Meeting and another at the 2020 AANS/CNS Section on Pediatric Neurological Surgery (PNSS), and achieved robust educational outcomes across Moore’s Levels 1–5. There were notable statistical advancements in clinician confidence, knowledge, and intention to employ targeted medical therapies for NF1-related symptomatic, inoperable plexiform neurofibromas from pre-activity to post-activity assessment, and many of these improvements were retained at 6-week follow-up analysis. In conclusion, our outcomes data evidence the critical need for responsive educational activities in the NF1 treatment space, especially as trial data continue to galvanize evolution of this novel pharmacologic armamentarium. Such activities possess the capacity to improve clinician confidence, advance knowledge, and promote utilization of targeted medical therapies in NF1, thereby optimizing patient outcomes.

Music Therapy and Nursing Cotreatment in Integrative Hospice and Palliative Care.

Integrative hospice and palliative care is a philosophy of treatment framing patients as whole persons composed of interrelated systems. The interdisciplinary treatment team is subsequently challenged to consider ethical and effective provision of holistic services that concomitantly address these systems at the end of life through cotreatment. Nurses and music therapists, as direct care professionals with consistent face-to-face contact with patients and caregivers, are well positioned to collaborate in providing holistic care. This article introduces processes of referral, assessment, and treatment that nurses and music therapists may engage in to address family support, spirituality, bereavement, and telehealth. Clinical vignettes are provided to illustrate how cotreatment may evolve and its potential benefits given diverse circumstances. As part of this framing, music therapy is positioned as a core—rather than alternative or complementary—service in hospice that satisfies the required counseling services detailed in Medicare's Conditions of Participation for hospice providers. The systematic and intentional partnering of nurses and music therapists can provide patients and caregivers access to quality comprehensive care that can cultivate healthy transitions through the dying process.

Building commitment to change: Lessons from DBT

Every day in my work as a therapist, supervisor, and clinical team member, I seek out opportunities to assess and strengthen commitment in myself and others. Much of what I do to build commitment I learned from dialectical behavior therapy (DBT). DBT describes commitment as an intention to take specific actions (or inaction) as a clear plan toward one's goal. Here I share lessons on commitment work in psychotherapy, which I have drawn from my training in DBT, my clinical experiences treating individuals and families with severe anxiety and emotion dysregulation, and my experiences both receiving and providing supervision and consultation on interdisciplinary treatment teams. First, I frame and flesh out commitment in the broader context of DBT. Then, I describe specific commitment strategies taught and practiced in DBT.

Ideal and real treatment planning processes for people with serious mental illness in public mental health care.

Treatment planning processes are a fundamental component of evidence-based practice in mental health for people with serious mental illness (SMI), who often present with complex concerns and require an interdisciplinary treatment team. It is unclear how well treatment planning practices in usual care settings for SMI adhere to best practices guidelines. In this study, we used qualitative methods to increase understanding of typical treatment planning practices. Twelve mental health providers completed a participatory dialogue focused on discussing perceptions of ideal and real treatment planning processes. Content analysis of the transcription from the dialogue was used to identify major themes and subthemes. Analysis revealed 6 primary themes with 23 subthemes. Providers described the ideal treatment planning process as dynamic and collaborative, including thorough assessment and inclusion of all stakeholders including the consumer, providers, and family members. Real treatment planning was described as directed by institutional and regulatory needs, resulting in treatment plans that were not personalized and not communicated to frontline staff or the consumer. These results indicate that providers have a strong understanding of evidence-based principles of treatment decision-making. However, actual treatment planning processes rarely live up to those principles. Providers identified several obstacles to enacting best practices. Although many obstacles were system-level, providers themselves also contributed to the gap between ideal and real treatment planning. Additional training and education may help to close this gap. Consumer self-advocacy is also important, given that providers often see themselves as lacking agency to make changes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Validating Psychometric Properties of a Revised Patient Version of the Combined Assessment of Psychiatric Environments (CAPE).

Measuring patient experience is an essential challenge in the inpatient behavioral health population. This initiative analyzed the psychometric properties of a revised version of the patient Combined Assessment of Psychiatric Environments (p-CAPE-R) survey. The p-CAPE was revised to encompass the interdisciplinary treatment team and implemented on five inpatient psychiatric units at an academic medical center. A psychometric analysis was performed on the p-CAPE-R. Analysis of factor loadings with a large sample (n = 786) revealed a more coherent item structure under the "staff competency and engagement" and "treatment effectiveness" domains than presented in the original instrument development research. Although the p-CAPE-R reflects a more useful and psychometrically sound instrument than the original p-CAPE, further analysis and revision to reflect the entire interdisciplinary team is warranted.